Nineteen health care organizations participating in the federal "Pioneer" accountable care organization demonstration program urged CMS officials in a letter sent in February to make certain changes to the program, including bolstering quality measures that will determine hospital performance.

About the Pioneer ACO Program

Under the program -- which centers on the idea to encourage quality of care over quantity -- CMS is testing a hospital reimbursement model that is based on a set of quality metrics.

The metrics were supposed to be supported by data culled from the hospitals in 2012, when the involved organizations were reimbursed simply for reporting on the quality statistics of their services, such as readmission rates and the number of mammograms. CMS was scheduled to start basing its reimbursements to the hospitals on the quality measures in 2013.

Letter Details

However, the hospitals said in the letter that the quality metrics are not yet supported by enough data and do not take into account the hospitals' baseline standards of care. The letter asked CMS to delay the pay-for-performance schedule until 2014 and use 2013 as another year to gather data.

Emily Brower, director of Accountable Care Programs at Atrius Health, said, "That would give us time to collect data and make the measures strong."

Elliott Fisher of Dartmouth College's School of Medicine -- who co-authored an Institute of Medicine study on ACOs -- said, "We don't actually know, until we collect more data, how hard it will be to meet some of those standards," adding, "So I think the argument in the letter is a reasonable way forward."

The hospitals have asked CMS to reply by April 2.

Retailers Back Republican Efforts To Repeal ACA's Employer Mandate

Meanwhile, National Retail Federation Senior Vice President David French has issued two letters supporting legislation (HR 903, S 399) that would repeal an Affordable Care Act provision requiring most employers to offer affordable health care coverage to their employees, The Hill's "On the Money" reports.

Under the ACA, businesses with at least 50 workers beginning in 2014 must pay a penalty of $2,000 per employee if they do not provide affordable coverage to their employees. Employers will not be required to pay for the first 30 workers who are included in the penalty calculation.

French addressed his letters to House and Senate sponsors of the bills, Sen. Orrin Hatch (R-Utah) and Rep. Charles Boustany (R-La.).

NRF previously has expressed concerns that employers would be discouraged from hiring or would let go of current employees in order to avoid the mandate. The repeal will "greatly aid the retail community, which is heavily dependent on labor," French wrote.

In related news, the "unknown effects" of implementing the ACA is causing a sluggish job market, according to a report released Wednesday by the Federal Reserve.

The report -- which examines economic conditions across the country -- found that employers in several areas "cited the unknown effects of the [ACA] as reasons for planned layoffs and reluctance to hire more staff."

The report pinpointed "rising premiums" as the main deterrent for hiring in certain areas, including Cleveland and Philadelphia.